|
LUMBAR PUNCTURE, SPINAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
LUMBAR PUNCTURE W/FLUORO OR CT 62328
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
5569369
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.61 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$71.61
|
| Rate for Payer: Anthem Medicare Advantage |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.61
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.61
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$305.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.61
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$107.42
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$71.61
|
| Rate for Payer: The Alliance Commercial |
$304.36
|
| Rate for Payer: United Healthcare Medicaid |
$208.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.61
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$322.26
|
|
|
LUMBAR SYMPATHECTOMY
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.39 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.82
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.64
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,994.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.11
|
| Rate for Payer: The Alliance Commercial |
$3,841.76
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
LUMBAR SYMPATHECTOMY
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2960398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.92 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,610.11
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
LUMPECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUMPECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUMPECTOMY, BREAST W/ ULTRASOUND GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUMPECTOMY, BREAST W/ ULTRASOUND GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUMPECTOMY, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2556799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUMPECTOMY, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2556799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$339,491.36
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$99,681.95 |
| Max. Negotiated Rate |
$339,491.36 |
| Rate for Payer: Aetna Managed Medicare |
$99,681.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282,563.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216,582.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205,767.28
|
| Rate for Payer: Anthem Medicare Advantage |
$99,681.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99,681.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99,681.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$99,681.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228,420.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$99,681.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99,681.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99,681.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$99,681.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$99,681.95
|
| Rate for Payer: NAPHCARE Commercial |
$149,522.93
|
| Rate for Payer: Quartz Medicare Advantage |
$99,681.95
|
| Rate for Payer: The Alliance Commercial |
$339,491.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99,681.95
|
| Rate for Payer: Wellcare Medicare |
$99,681.95
|
|
|
Lupron Depo 7.5 mg Charge
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
Lupron Depo 7.5 mg Charge
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.75 |
| Max. Negotiated Rate |
$667.01 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$166.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Anthem Medicare Advantage |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$166.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$166.75
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$166.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$166.75
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$250.13
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$166.75
|
| Rate for Payer: The Alliance Commercial |
$667.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.75
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: Wellcare Medicare |
$166.75
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Lupron Depo 7.5 mg Charge
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.75 |
| Max. Negotiated Rate |
$482.72 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$166.75
|
| Rate for Payer: Anthem Medicare Advantage |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.75
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$250.13
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$166.75
|
| Rate for Payer: The Alliance Commercial |
$458.57
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.75
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
LURIA NEBRASKA BATTERY
|
Facility
|
IP
|
$1,089.00
|
|
| Hospital Charge Code |
2972007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$554.95 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Aetna Commercial |
$1,019.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.26
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna Commercial |
$1,041.96
|
| Rate for Payer: Health EOS Commercial |
$1,007.98
|
| Rate for Payer: HFN Commercial |
$1,041.96
|
| Rate for Payer: Multiplan Commercial |
$906.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,041.96
|
| Rate for Payer: Quartz Beloit One Network |
$554.95
|
| Rate for Payer: Quartz Commercial |
$679.54
|
| Rate for Payer: WEA Trust Commercial |
$622.91
|
| Rate for Payer: WPS Commercial |
$838.86
|
|
|
LURIA NEBRASKA BATTERY
|
Facility
|
OP
|
$1,089.00
|
|
| Hospital Charge Code |
2972007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Aetna Commercial |
$1,019.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.00
|
| Rate for Payer: Aetna Managed Medicare |
$317.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$736.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$543.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.26
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna Commercial |
$1,041.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$633.80
|
| Rate for Payer: Health EOS Commercial |
$1,007.98
|
| Rate for Payer: HFN Commercial |
$1,041.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$849.42
|
| Rate for Payer: Multiplan Commercial |
$906.05
|
| Rate for Payer: NAPHCARE Commercial |
$679.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,041.96
|
| Rate for Payer: Quartz Beloit One Network |
$554.95
|
| Rate for Payer: Quartz Commercial |
$736.16
|
| Rate for Payer: Quartz Medicare Advantage |
$679.54
|
| Rate for Payer: The Alliance Commercial |
$566.28
|
| Rate for Payer: WEA Trust Commercial |
$622.91
|
| Rate for Payer: WPS Commercial |
$838.86
|
|
|
Luteinizing Hormone Level
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Luteinizing Hormone Level
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$343.82 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$343.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$329.35
|
| Rate for Payer: HFN Commercial |
$343.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$343.82
|
| Rate for Payer: Quartz Beloit One Network |
$159.24
|
| Rate for Payer: Quartz Commercial |
$206.29
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$76.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$84.75
|
|
|
Luteinizing Hormone Level
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.97
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$77.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: United Healthcare PPO |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: Wellcare Medicare |
$19.26
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$126.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$121.14
|
| Rate for Payer: HFN Commercial |
$126.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$126.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.57
|
| Rate for Payer: Quartz Commercial |
$75.88
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
